Author Question: A nurse is caring for a client on IV infusion of heparin. What actions does this nurse include in ... (Read 78 times)

@Brianna17 · **on:** Jun 25, 2018

A nurse is caring for a client on IV infusion of heparin. What actions does this nurse include in the client's plan of care? (Select all that apply.)

a. Assess the client for bleeding.
b. Monitor the daily activated partial thromboplastin time (aPTT) results.
c. Stop the IV for aPTT above baseline.
d. Use an IV pump for the infusion.
e. Weigh the client daily on the same scale.

Question 2

Which statements by the client indicate good understanding of foot care in peripheral vascular disease? (Select all that apply.)

a. A good abrasive pumice stone will keep my feet soft.
b. I'll always wear shoes if I can buy cheap flip-flops.
c. I will keep my feet dry, especially between the toes.
d. Lotion is important to keep my feet smooth and soft.
e. Washing my feet in room-temperature water is best.

fur · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: A, B, D
Assessing for bleeding, monitoring aPTT, and using an IV pump for the infusion are all important safety measures for heparin to prevent injury from bleeding. The aPTT needs to be 1.5 to 2 times normal in order to demonstrate that the heparin is therapeutic. Weighing the client is not related.

Answer to Question 2

ANS: C, D, E
Good foot care includes appropriate hygiene and injury prevention. Keeping the feet dry; wearing good, comfortable shoes; using lotion; washing the feet in room-temperature water; and cutting the nails straight across are all important measures. Abrasive material such as pumice stones should not be used. Cheap flip-flops may not fit well and won't offer much protection against injury.